Objective: To identify maternal and infantile risk factors for retinopathy of prematurity (ROP) among preterm infants screened in St. Luke’s Medical Center, Quezon City (SLMC-QC) from 2014-2017. Methods: This was a retrospective study that included the ROP databank of the Eye Institute and the Research and Biotechnology Group of St. Luke’s Medical Center, Quezon City from 2014 to 2017. This study included medical records of all premature infants screened for ROP and excluded those who had incomplete data or other ocular pathologies other than ROP. Risk factors were analyzed using univariate analysis. Odds ratio (OR) and 95% confidence interval (CI) were also calculated with significant P value set at <0.05. Results: Among the 455 infants screened for ROP, 118 (25.9%) had any stage of ROP while 23 (5.0%) had treatment-warranted ROP (TW-ROP). Univariate regression analysis showed that the top 5 infantile risk factors associated with any stage of ROP and TW-ROP were low birth weight (97.5% and 100%, respectively), prematurity (87.3% and 100%, respectively), history of blood transfusion (21.2% and 13%, respectively), sepsis (21.2% and 17.4%, respectively), and oxygen supplementation (16.1% and 8.7%, respectively). After multivariate analyses, the most important adjusted risk factors associated with any stage of ROP include low birth weight (OR 52, CI 16.20166.96, P =0.001), prematurity (OR 25.73, CI 14.10-46.95, P =0.001), and history of blood transfusion (OR 8.79, CI 4.08-18.96, P =0.0001). Conclusion The most significant infantile risk factors associated with any ROP include low birth weight, prematurity, and history of blood transfusion. There were no significant probable maternal risk factors. Timely ROP screening is recommended especially among infants with any of these risk factors in their profile.
Retinopathy of Prematurity ; Risk Factors ; Blood Transfusion ; Infant, Low Birth Weight

The effect of the trace elements on retinopathy of prematurity (ROP) were studied. Thirty preterm infants who had potential high risk factors of ROP were selected as observation group and 18 normal infants as control groups. By using atom spectrophotometer, the contents of serum trace elements (Mg, Cu, Zn, Mn, Se) were measured and analyzed statistically. The contents of serum Zn, Cu and Se in observation group were 0.75+/-0.22, 0.41+/-0.20 and (134.07+/-71.57)x10(-3) mg/L respectively, and 0.55+/-0.12, 0.65+/-0.194 and (202.92+/-44.71)x10(-3) mg/L in control group respectively (P<0.01). The contents of Cu and Se were obviously lower and that of Zn higher in observation group than those in control group. The same results were obtained between the infants with ROP and controls (P<0.01). However, there was no significant difference in the contents of serum Mg and Mn between two groups (P>0.05). It was concluded that the contents of serum Cu and Se in preterm infants who had high risk factors of ROP were obviously lower than in the controls. The contents of serum Cu and Se in the ROP infants were also much lower while contents of Zn much higher. Attention should be paid to the detection of the trace elements in preterm infants in order to prevent the deficiencies of Cu and Se. Only in this way can we prevent the deficiencies of Cu and Se, so as to decrease the ROP risk factors and prevent the disease.
Copper/blood ; Infant, Premature/*blood ; Retinopathy of Prematurity/*blood ; Retinopathy of Prematurity/*prevention & control ; Risk Factors ; Selenium/blood ; Spectrophotometry, Atomic ; Trace Elements/*blood ; Zinc/blood

OBJECTIVETo explore an optimal oxygen saturation for extremely preterm infants based on a systemic review of the published studies.

METHODSA Meta analysis of the published studies by the NeOProM Group which compared the outcomes of extremely preterm infants (gestational age <28 weeks) maintained in either a low (85%-89%) or high (91%-95%) oxygen saturation (SpO2) by using the STATA 12.0. The outcomes measured included the mortality and the incidences of retinopathy of prematurity (ROP), necrotizing enterocolitis of newborn (NEC), broncho-pulmonary dysplasia (BPD), intraventricular hemorrhage (IVH) and patent ductus arteriosus (PDA).

RESULTSThree studies were included, in which 2 460 infants were assigned into the low SpO2 group and 2 459 infants in the high SpO2 group. The Meta analysis demonstrated that the risk of mortality before discharge or at the age of 18 months increased in the low SpO2 group compared with the high SpO2 group (RR: 1.19; 95%CI: 1.05-1.35); the risk of ROP decreased in the low SpO2 group (RR: 0.73; 95%CI: 0.53-1.00); the risk of NEC increased in the low SpO2 group (RR: 1.26; 95%CI: 1.06-1.49). There was no significance in the incidences of BPD, IVH and PDA between the two groups.

CONCLUSIONSMaintaining SpO2 at 85%-89% may decrease the incidence of ROP, but increase the mortality rate and the incidence of NEC in extremely premature infants.

Enterocolitis, Necrotizing ; etiology ; Humans ; Infant ; Infant Mortality ; Infant, Extremely Premature ; metabolism ; Outcome Assessment (Health Care) ; Oxygen ; blood ; Retinopathy of Prematurity ; etiology

OBJECTIVE: This study was conducted to evaluate the incidence, the optimal timing of screening examinations for retinopathy of prematurity(ROP) and to analyze perinatal risk factors associated with cryotherapy or lasertherapy(CT/LT) in ROP. METHODS: Medical records of 130 very low birth weight(VLBW) infants who admitted to the NICU of Wonkwang University Hospital from July 1997 to June 2002 were reviewed retrospectively. We evaluated the incidence and severity of ROP by gestational age(GA) and birth weight(BW). And the comparisons of perinatal risk factors between ROP with and without CT/LT have been made. RESULTS: Incidence of ROP was 36.9% and mean GA and BW were 29.1+/-1.99 weeks, 1,153+/-209 gm in VLBW infants respectively. ROP Stage II or greater was 15.4% of VLBW infants, 41.7% of ROP infants, and 27.1% of ROP infants were treated with CT/LT. All infants with BW <750gm or GA <26 weeks were developed ROP with stage II or greater and treated with CT/LT. First detection of ROP was performed at chronologic age(CA) 3 weeks, postconceptional age(PCA) 30 weeks, and first identification of threshold ROP needed with CT/LT were at CA 5 weeks and PCA 33 weeks. The perinatal risk factors with CT/LT for ROP were significant in GA, BW, Apgar score at 1 and 5 minutes and number of blood transfusion. The mean time of spontaneous regression is 13.4+/-8.8 weeks in the mild ROP infants without CT/LT. CONCLUSION: The incidence of ROP is 36.9% and the optimal timing of screening for ROP should be selected by earlier time in 2 guidelines of at 5 weeks of CA and 33 weeks of PCA in VLBW infants. And the related risk factors with CT/LT for threshold ROP were GA, BW and Apgar score at 1 and 5 minutes and number of blood transfusions.
Apgar Score ; Blood Transfusion ; Cryotherapy ; Humans ; Incidence* ; Infant* ; Infant, Very Low Birth Weight* ; Mass Screening* ; Medical Records ; Parturition ; Passive Cutaneous Anaphylaxis ; Retinopathy of Prematurity* ; Retrospective Studies ; Risk Factors*

In order to investigate the risk factors of retinopathy of prematurity, we retrospectively reviewed the medical records of 153 premature badies alive and born in our hospital between October 1994 and January 1997. We performed analysis on birth weight, gestational age, duration of oxygen therapy, duration of oxygen therapy more than 40 percent, maxinmum and mean value of oxygen pressute and mean value of carbon dioxide pressure from arterial blood gas analysis in the first 2 weeks, the presence of multiple birth, surfactant therapy, corticosteroid therapy, and intraventricular hemorrhage. In univatiate analysis, birth weight, duration of oxygen therapy, value of oxygen pressure and mean value of carbon dioxide pressure from arterial blood gas analysis in the first 2 weeks, surfactant therapy, and corticosteroid therapy were statistically significant(p<0.05). Howeverm, in stepwise logistic regression analysis to correct the correlations in multiple variables, only birth weight and duration of oxygen therapy were significant risk factors in 95% confidence interval( 0.05, p<0.05). Birth weight, duration of oxygen therapy, and maximum value of oxygen pressure from arterial blood gas analysis in the first 2 weeks were significant risk factors in 90% confidence interval( 0.1, p<0.1).
Birth Weight ; Blood Gas Analysis ; Carbon Dioxide ; Gestational Age ; Hemorrhage ; Humans ; Logistic Models ; Medical Records ; Multiple Birth Offspring ; Oxygen ; Retinopathy of Prematurity* ; Retrospective Studies ; Risk Factors*

PURPOSE: To analyze related factors of retinopathy of prematurity by comparing between premature twins in which retinopathy developed on one twin. METHODS: A retrospective survey consisting of 13 premature twins in which retinopathy of prematurity (stage 1 or more) developed on one twin was performed. All twins were born in Kosin University Gospel Hospital. The twins were separated into two groups according to whether they had retinopathy of prematurity: the retinopathy of prematurity (ROP) group and non-ROP group. The twins' gestational age, weight, sex, Apgar score, treatments, blood tests, and neonatal complications were investigated. RESULTS: There were no significant differences between the twins except platelet count and aspartate aminotransferase. Platelet count was 191 (±46) ×10³/µL in the ROP group and 240 (±77) ×10³/µL in the non-ROP group, a significant difference (p = 0.046). Aspartate aminotransferase was 36 (±26.6) IU/L in the ROP group and 22 (±5.9) IU/L in the non-ROP group, a significant difference (p = 0.019). CONCLUSIONS: In conclusion, we found platelet count and aspartate aminotransferase to be significant factors related to development of retinopathy of prematurity. It is thought that these factors should be considered when screening for ROP, although a larger prospective study is be needed before the results can be applied in clinical practice.
Apgar Score ; Aspartate Aminotransferases ; Blood Platelets ; Gestational Age ; Hematologic Tests ; Humans ; Mass Screening ; Platelet Count ; Prospective Studies ; Retinopathy of Prematurity ; Retrospective Studies ; Twins*

OBJECTIVETo investigate the role of oxidative stress in the pathogenesis of retinal injury induced by hyperoxia.

METHODSSixty immature Sprague-Dawley (SD) rats born at a gestational age of 21 days, were randomly exposed to room air (air group, n=30) or 95% oxygen (hyperoxia group, n=30) immediately after birth. Plasma 8-iso-prostaglandin F2alpha (8-iso-PGF2alpha) levels were determined by ELISA. The ultrastructures of the retina were observed under a transmission electron microscope.

RESULTSThe plasma 8-iso-PGF2alpha contents of the air group were 19.09 +/-5.57, 18.24+/-5.91 and 17.00 +/- 5.58 pg/mL on the 3rd, 7th and 14th days after birth, respectively (F=1.024, P> 0.05). The plasma 8-iso-PGF2 contents in the hyperoxia group on the 3rd (28.33 +/- 5.59 pg/mL), the 7th day (51.20 +/- 15.01 pg/mL) and 14th day (84.54 +/- 14.85 pg/mL) after birth were significantly higher than those of the air group (t=2.863, P< 0.05; t=5.073, P< 0.01; t=11.006, P< 0.01). Moreover, the plasma 8-iso-PGF2 contents in the hyperoxia group increased with the prolonged hyperoxia exposure (F=150.7, P < 0.01). The ultrastructures of retina in the air group were normal. Hyperoxia exposure resulted in abnormalities of the ultrastructures of retina, manifesting as the membrane discs rarefied, twisted and disrupted and mitochondrial swelling.

CONCLUSIONSOxidative stress can results in retinal injury in immature rats. An increased plasma level of 8-iso-PGF2alpha is related to the injury degree of retina.

Animals ; Dinoprost ; analogs & derivatives ; blood ; Humans ; Hyperoxia ; complications ; metabolism ; pathology ; Infant, Newborn ; Lipid Peroxidation ; Oxidative Stress ; Rats ; Rats, Sprague-Dawley ; Retina ; metabolism ; pathology ; ultrastructure ; Retinopathy of Prematurity ; etiology

INTRODUCTIONRetinopathy of prematurity (ROP) can lead to severe visual impairment. This study was conducted to determine the levels of biochemical mediators (i. e. vascular endothelial growth f actor [ VEGF] and insulin- like growth factor-1 [IGF-1]) in the blood of premature infants with proliferative ROP.

METHODSBlood samples from 71 preterm infants born at or before 32 weeks of gestation were obtained 6-8 weeks after birth. These infants were classified into two groups according to their eye examination results. The control group consisted of 41 infants who had no evidence of ROP, and the study group consisted of 30 infants with proliferative ROP at stage III or higher. Blood VEGF and IGF-1 levels were measured using enzyme-linked immunosorbent assay.

RESULTSThe mean gestational ages of the infants at birth were 28.4 ± 1.6 and 28.8 ± 1.6 weeks in the study and control groups, respectively (p = 0.259). The mean postmenstrual age of the infants at the time of blood sampling was 34.9 ± 1.2 weeks in the study group and 34.6 ± 1.3 weeks in the control group (p = 0.339). The mean blood IGF-1 (18.48 ± 11.79 µg/L and 16.75 ± 13.74 µg/L in the study and control groups, respectively; p = 0.580) and VEGF (267.35 ± 103.43 pg/mL and 237.52 ± 130.92 pg/mL in the study and control groups, respectively; p = 0.305) levels of the infants were not significantly different between the two groups.

CONCLUSIONAt 6-8 weeks after birth, blood IGF-1 and VEGF levels were not found to be significantly different between premature infants with proliferative ROP and those without.

Case-Control Studies ; Enzyme-Linked Immunosorbent Assay ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Infant, Premature ; Insulin-Like Growth Factor I ; metabolism ; Intensive Care, Neonatal ; Male ; Pulmonary Surfactants ; therapeutic use ; Retinopathy of Prematurity ; blood ; Vascular Endothelial Growth Factor A ; blood

PURPOSE: To determine the effect of changing practice guidelines designed to avoid hyperoxia or hypoxia in very low birth weight or very preterm infants. METHODS: We analyzed a database of <1,500 g birth weight or <32 weeks of gestation infants who were born and admitted to the neonatal intensive care unit of Chungnam National University Hospital from January 2007 to July 2010. First, we defined the relationship between arterial partial pressure of oxygen (PaO2) and pulse oxygen saturation (SpO2). When we evaluated 96 pairs of PaO2 and SpO2 measurements, oxygen saturation was 90-94% at a PaO2 of 43-79 mmHg on the oxyhemoglobin dissociation curve, according to pulse oximetry. Based on this observation, a change in practice was instituted in August 2008 with the objective of avoiding hypoxia and hyperoxia in preterm infants with targeting a SpO2 90-94% (period II). Before the change in practice, high alarms for SpO2 were set at 100% and low alarms at 95% (period I). RESULTS: Sixty-eight infants the met enrollment criteria and 38 (56%) were born during period II, after the change in SpO2 targets. Demographic characteristics, except gender, were similar between the infants born in both periods. After correcting for the effect of confounding factors, the rates for mortality, severe retinopathy of prematurity, and IVH attended to be lower than those for infants in period II. No difference in the rate of patent ductus arteriosus needed to treat was observed. CONCLUSION: A change in the practice guidelines aimed at avoiding low oxygen saturation and hyperoxia did not increase neonatal complication rates and showed promising results, suggesting decreased mortality and improvements in short term morbidity. It is still unclear what range of oxygen saturation is appropriate for very preterm infants but the more careful saturation targeting guideline should be considered to prevent hypoxemic events and hyperoxia.
Anoxia ; Birth Weight ; Blood Gas Analysis ; Dissociative Disorders ; Ductus Arteriosus, Patent ; Humans ; Hyperoxia ; Infant ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Intensive Care, Neonatal ; Oximetry ; Oxygen ; Oxyhemoglobins ; Partial Pressure ; Pregnancy ; Retinopathy of Prematurity

The incidence of retinopathy of prematurity(ROP) was observed in 194 infants admitted in our nursery room, who had birthweighs less than 2000 gm, or who had gestational ages less than 37 weeks and received supplemental oxygen therapy. To minimize the multiple correlation of birthweights and gestational ages with other possible risk factors of ROP, we selected a control group of normal infants whose birthweights or gestational ages were similar to ROP group, and then other risk factors were analyzed statisticully through a case-control study. Among 194 infants, 41 infants(21%) were diagnosed as ROP. The incidence of ROP was 48%(24/50) in infants with birthweights less than 1500 gm , 41%(28/68) in infants with gestational ages less than 32 weeks(p<0.001). In the case-control study, there were statistically significant differences in the duration of oxygen therapy and the maximal oxygen concentration betweenROP and control group, and long duration(>or=5 days) ahd high concentration(>or=40%) were highly associated with ROP(p<0.01). Other statistically significant risk factors included mechanical ventilation duration, 5 minutes Apgar score, apnea of prematurity, blood transfusion, anemia, asphyxia neonatorum, respiratory distress syndrome, xanthine administration, and parity, cesarean section, pregnancy induced hypertension in mother's factors(p<0.05).
Anemia ; Apgar Score ; Apnea ; Asphyxia Neonatorum ; Blood Transfusion ; Case-Control Studies ; Cesarean Section ; Female ; Gestational Age ; Humans ; Hypertension, Pregnancy-Induced ; Incidence* ; Infant ; Infant, Newborn ; Nurseries ; Oxygen ; Parity ; Pregnancy ; Respiration, Artificial ; Retinopathy of Prematurity* ; Risk Factors* ; Xanthine